Reproducibility assessment of Delaire cephalometric analysis using reconstructions from computed tomography.

INTRODUCTION: Cephalometry performed on sagittal teleradiographic X-rays is commonly used for the planification of orthognathic procedures. Tomographic imaging techniques (computer tomography or cone-beam computer tomography) are more and more prescribed for the assessment of complex occlusofacial anomalies. In this study, we intended to evaluate if teleradiographic X-rays reconstructed from computer tomography (CT) can be used to trace reliable cephalometric analyses. We assessed the inter- and intra-observer reproducibility of a simplified Delaire analysis (Top 12), one of the numerous common cephalometric analyses, performed with the Delaire Evolution software on three sets of X-rays: (1) conventional cephalometric X-rays, (2) 2D reconstructions obtained from the CT scans of the same patients and (3) 2D reconstructions obtained from CT scans of dry skulls without a cervical spine (anthropological material). Our primary goal was to assess X-rays reconstructed from tomographies as an alternative for conventional cephalometric X-rays. Our secondary goal was to assess whether computerized cephalometric analysis was a reproducible technique, both on clinical and anthropological material. MATERIALS AND METHODS: We included 10 consecutive adult patients admitted for orthodontic assessment who had benefited from both lateral cephalometric X-rays and from CT-scans. We also included 10 CT-scans from adult dry skulls without a cervical spine, from the collections of the Muséum National d'Histoire Naturelle (Musée de l'Homme, Paris, France). Cephalometric X-rays were reconstructed from CT-scans of both patients and dry skulls using Carestream® (Carestream Health inc., New York, USA). Simplified Delaire analyses (Top12) were conducted by 2 observers using the Delaire Evolution software (JDel, Nantes, France), on the 3 sets of cephalometric X-rays: (1) 10 standard cephalometric X-rays from the orthodontic patients, (2) 10 reconstructed cephalometric X-rays from the CT scans of the orthodontic patients and (3) 10 reconstructed cephalometric X-rays from the CT scans of the dry skulls. A standard statistical assessment of reproducibility was conducted using correlation coefficients. RESULTS: We found good inter- and intra-observer reproducibility for standard cephalometric X-rays and reconstructed cephalometric X-rays (Intraclass Correlation Coeficient > 0.75). We did not find any difference for angle measures between the standard cephalometric X-rays and the reconstructed cephalometric X-rays for the group of orthodontic patients (P > 0.05). Delaire cephalometric analysis was not reproducible for cephalometric X-rays without a cervical spine, that is for cephalometric X-rays reconstructed from the CT-scans of dry skulls. DISCUSSION: Delaire computerized simplified Top12 analysis was reproducible for lateral cephalometric X-rays and for reconstructions obtained from CT scans with similar angle measures for a given patient. This analysis does not seem to be reliable for dry skulls without upper cervical spine. This study uses the example of one particular computerized cephalometric analysis in order to show that cephalometric analyses can be performed on lateral reconstructed cephalometric X-rays obtained from CT scans.

A sore throat.

The authors report an unusual case of penetrating anterior neck injury in a 71-year-old female patient, who intentionally stabbed herself in a suicide attempt. The initial clinical and radiological assessment revealed that the knife had pierced through the sixth vertebral body and spinal cord, avoiding all the vital structures on the way. Surgical removal of the knife was successfully performed, and the patient was rapidly discharged, with mild neurological impairment. Although frequently described in posterior locations, neurological lesions are rare in anterior neck injuries. This case emphasizes the fact that a thorough neurological examination should be conducted in all neck injuries.

A case of epistaxis.

The authors report a case of epistaxis in a 74-year-old male patient. His recent medical history documented recurrent nasal bleeding and a Le Fort 1 osteosynthesis 3 weeks before admission to our unit. A CT scan revealed a left descending palatine artery pseudoaneurysm in the left maxillary sinus that was successfully embolized. Pseudoaneurysms of the internal maxillary artery and its branches are rare life-threatening complications. This diagnosis should be considered when confronted to recurrent head and neck bleeding, especially in a context of recent maxillo-facial trauma or surgery. Embolization should rapidly be implemented.

Routine mini-laparoscopic cholecystectomy: Outcome in 200 patients.

INTRODUCTION: In order to improve the outcome of classical laparoscopic cholecystectomy (CLC), surgeons have attempted to minimize tissue trauma. The aim of this study is to describe the technique of mini-laparoscopic cholecystectomy (MLC) and to report the outcome of this approach when used as a routine procedure. METHODS: Since January 2012, all consecutive patients undergoing MLC were included in this study. Operative and perioperative data were prospectively collected. Additionally, cost analysis was performed. RESULTS: From 2012 to 2015, 200 MLC were performed (F/M: 132/68, mean age 45±16 years). Mean operative duration was 97±32min for the first 50 patients and 75±25min for the subsequent 150 patients (P<0.0001). Modifications in the number or size of trocars were necessary in nine of the first 50 procedures and in seven of the subsequent 150 procedures (P=0.003). Perioperative morbidity included gallbladder perforation (n=28) or moderate (<50mL) bleeding (n=6). Postoperative morbidity was 4%. The mean global cost for a MLC procedure was 1757±1855 euros. This cost decreased from 2946±3115 euros in the first 50 patients to 1390±1278 euros in the subsequent 150 patients (P=0.001). CONCLUSION: Mini-laparoscopy can be used for routine elective cholecystectomy. This approach is associated with low morbidity and good cosmetic results.

[Orbital congenital nevi: Principles of treatment about 51 cases]. / Nævi orbitaires congénitaux: principes de prise en charge thérapeutique à propos de 51 cas.

INTRODUCTION: The incidence of congenital nevi is one over 20,000 newborns per year, 14 % of them are located in the head and neck area. Nevi of the orbital region are particularly difficult to handle on the aesthetic and functional side. The objectives of this study were to conduct an analysis of different clinical presentations of congenital nevi of the eyelid orbital region in children to establish a treatment algorithm. MATERIEL AND METHODS: We realised a bi-centric retrospective study including 51 children with orbito-palpebral congenital nevi. We analysed the different clinical presentations, their treatments and their results. RESULTS: Nineteen underwent direct suture excision; three a total skin graft; 15 a combination of treatments, among them four underwent tissular expansion and 14 patients were not operated and clinically followed-up. The average follow-up time was 6.6 years. In 33 cases residual nevic area was still present. The postoperative sequelae were: dyschromia (n=17), anatomical deformation of the eye (n=10), nevi outbreaks (n=8), internal canthus deformation (n=5) and ectropion (n=1). CONCLUSION: The results of our study show that therapeutic abstention is preferred when the aesthetic wrong is accepted by the patient and when there is not a higher risk of malignant degeneration. In order to minimise the risk of postoperative sequelae, we propose a therapeutic algorithm for the management of congenital orbital nevi.

[Superolateral dislocation of the temporomadibular joint: Case report]. / Luxations supéro-externes bilatérales de l'articulation temporo-mandibulaire: à propos d'un cas.

INTRODUCTION: Superolateral disclocations of the temporomandibular joint are rare. They mostly occur after high-energy trauma and are frequently associated with fractures of the mandibular body. CASE REPORT: A 35-year-old man was admitted for the management of a high-energy craniofacial trauma due to a road accident. The initial assessment revealed bilateral superolateral temporomandibular joint disclocations, with bilateral sagittal fractures of the condyle head and a fracture of the right parasymphysis. The treatment consisted in an external reduction of both condyles, followed by open reduction and internal fixation of the parasymphysis. The patient quickly started physiotherapy after the procedure and recovered a normal mouth opening after a month of follow-up. DISCUSSION: For most authors, a quick management of superolateral dislocations is necessary in order to achieve a proper reduction of the temporomandibular joint dislocation and avoid surgical reduction. Temporomandibular joint ankylosis is the main complication of such lesions. Early physiotherapy is indicated in order to prevent ankylosis.